Winning Service Connection for a Non-PTSD Psychiatric Disability Without Evidence of In-Service Psychiatric Problems

– Eric Gang, June 24th 2015

For non-PTSD psychiatric cases, proving a service connection between metal illness and military service still requires you to establish the occurrence of an in-service event linking the two. Normally, you need to have a service treatment record documenting some psychiatric complaints. At the very least, you need to have a complaint of nervous trouble noted on your separation history.

But as a veterans disability lawyer, I know that soldiers are reluctant to report psychiatric problems. Doing so contradicts the unwritten code of machismo that permeates military culture. To complain of issues like depression, anxiety or even hallucinations is considered weak and weakness is not allowed. In addition, there are situations where no psychiatric symptoms were present during service thus making connecting psychiatric problems with military service even more difficult.

With PTSD, we can point to combat with the enemy or witnessing the death of friends to prove service connection. So how do you link a current psychiatric disability to military service when you have no record of an in-service event? What we’re talking about here is non-PTSD psychiatric illnesses that cannot be linked to any external stressful events. Most advocates working with veterans to qualify for benefits would consider it impossible to establish a service connection for a non-PTSD psychiatric disability without an obvious in-service mental health complaint. However, because an experienced veterans disability benefits lawyer knows how to think creatively about how to approach the issue.

Our veterans disability law firm recently represented a veteran who suffered from multiple psychiatric issues including psychosis, depression, and PTSD. There were no verifiable stressors in his records; he did not have combat exposure, and there were zero psychiatric complaints noted in the service treatment records. In fact, his service medical records contained the usual litany of common ailments such as a cough, sore throat, sore muscles, dental problems, and the usual venereal diseases. To the casual observer, there was nothing of a psychiatric nature in the service treatment records. After all, symptoms of the common cold have no significance. Similarly, the usual venereal diseases have been a ubiquitous part of military service throughout history.

Syphilis has had a deleterious impact on U.S. military personnel throughout history–dating all the way back to the Revolutionary War. According to a 1944 article in the journal Modern Clinical Syphilology, during WWII draftees from the southern Atlantic states had syphilis infection rates as high as 11.3 percent.

Although the exact origins of syphilis are unknown, it was first describe in Europe in 1530 by Italian physician and poet Giralomo Fracastro. Throughout history syphilis has been considered a frightening disease and outbreaks were recorded across Europe during the Middle Ages. But during the latter part of the 20th century and early 21st century, syphilis became much less common and, as a result, many physicians are not well-versed in the progression of the disease. This lack of familiarity combines with the disease’s stealthy characteristics to result in many undiagnosed or misdiagnosed cases.

What makes syphilis so hard to diagnose is that it can include a wide range of symptoms over a long period of time. While syphilis can be contracted in other ways, it is primarily transmitted by sexual contact. Like other types of venereal disease, early symptoms include lesions on the penis. The second stage of the disease occurs 4 – 10 weeks after the initial infections and can include a rash on the torso, palms and souls of the feet. Symptoms can also include fever, sore throat, malaise, weight loss, hair loss, and headache. Then the disease can go latent for years before it moves into the third phase 3 – 15 years after the initial infection. There are different types of syphilis at this stage but symptoms can include gummas (soft, tumor like balls of inflammation) on the skin, bones or liver; neurological symptoms such as boor balance, sharp pains in the legs, apathy, seizures and dementia; and heart problems such as aneurysms.

Another problem with accurately diagnosing syphilis is that it has many symptoms in common with Lyme’s Disease which has become more common in the 21st century. It is also helpful to know that although the presentation of gonorrhea and syphilis are different, the U.S. Army Medical Department has found that out of 102,334 drafted men with gonorrhea, 27,140 also had syphilis. So, roughly 1 in 5 soldiers with gonorrhea also had syphilis. The treatment is often adequate to resolve the gonorrhea but not the syphilis, which progresses to the latent, inactive phase.

Here’s where the novice advocate and the seasoned lawyer part ways. Because I have spent hundreds of hours over the years studying the symptoms of physical and psychiatric problems typically experienced by soldiers and veterans, I knew the venereal disease diagnosis was the hook upon which we were able to hang our proverbial service-connection hat. In this case, the veteran’s records documented venereal disease symptoms such a penile discharge, skin rash, swollen lymph nodes, and pain on urination. The medical corps assumed a diagnosis of gonorrhea and prescribed some pills to treat it. However, the problem persisted for some time and his records included a reference to possible chicken pox. Also, buried in the service treatment records–in almost illegible handwriting–was a notation of “r/o syphilis” but there was no evidence that the medical corps did any work up to actually rule out syphilis.

Because of my research, I knew that the neuro-syphilis condition typical of the third phase of syphilis includes psychiatric problems such as the ones my client was experiencing. Although this veteran had a prior veterans disability lawyer, no one had developed the neuro-syphilis theory. So, I engaged a well-respected forensic psychiatrist who has had extensive experience treating VD cases during his time as a member of the medical corps in the Soviet military. Because of a decline in syphilis during the latter part of the 20th century, present-day physicians usually have less familiarity with the disease and its psychiatric consequences. The strategy here involves establishing by expert testimony that our client had undiagnosed syphilis in service that progressed to the latent stage, resulting in a psychiatric pathology.

The lesson in all this is that you should analyze very carefully the service treatment records to determine if venereal disease was noted. If it was gonorrhea, there is a 1 in 5 chance that there was concurrent syphilis that may have gone undiagnosed, passing into the latent stage. In turn, this can cause neurological and psychiatric problems in the subsequent years. The syphilis-psychiatric connection should be explored in cases of mental illness. For anyone with a VA appeal for the denial of VA benefits, great care should be taken to fully research the possible underlying diseases of any symptoms noted in the service treatment records.

As an experienced VA appeals lawyer, I realize that understanding these medical connections is not easy. There’s also no easy way to gain the sufficient medical proficiency to see these types of connections. It comes from years of experience. If the VA has recently denied you for a mental disability, and you don’t know where to turn, then I invite you to contact our office.

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Eric A. Gang, Esq. is a veterans’ disability attorney who represents disabled veterans nationwide in their appeals for VA disability benefits. He has litigated over 500 appeals at the U.S. Court of Appeals for Veterans Claims and has recovered millions of dollars in retroactive benefits for disabled veterans. His work has been mentioned in media outlets across the country. He publishes and lectures widely in the area of veterans benefits. You can reach him at (888) 878-9350 or www.veteransdisabilityinfo.com.